Healthcare Provider Details

I. General information

NPI: 1699478982
Provider Name (Legal Business Name): AVERY ALEXANDRA STEC DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVERY ALEXANDRA MUSHINSKI

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-785-5881
  • Fax: 518-785-1574
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: